About me.
Hi, my name is Catherine Bautista MS, CNS, OCN. I am a registered nurse with a bachelors degree from Villanova University and a masters degree as a clinical nurse specialist (CNS) from Hunter College with 12 years of experience in oncology nursing.
A CNS is defined as an advanced practice registered nurse. CNSs hold graduate degrees in nursing and are experts in a particular speciality. Regardless of specialty or setting, CNSs provide leadership in clinical expertise, nursing practice and systems innovation (NACNS, 2022). As a CNS I have the expertise to recognize gaps in health care delivery and the knowledge and skills to gather the necessary resources to address these issues. Through extensive research and experience CNSs are able to apply, and assess these resources in order to improve healthcare delivery and outcomes.
My Recovery After Birth.
After having my first child at 34 years old, I became acutely aware of the lack of resources available to mothers recovering after birth. I naively thought that my obstetrician would have all the answers and that any issues I faced in the postpartum period would not be serious. I had never heard of other mothers talking about any issues with their bodies after having a baby and they always seemed so happy when you would see them 6 months to a year later. I was healthy and active prior to having a baby. I walked 40 minutes total for my commute to work 4 times a week, plus exercised doing strength and cardio at home 3-4 times a week. My strength training included light weights and yoga. My cardio workouts included a pregnancy workout through Expectful (great app for expecting mothers, would highly recommend) and Dancebody- a fun HIIT style dance workout that I had done for years. I felt invincible and that surely my body would “bounce back” after having a baby.
Early in my second trimester I began to experience a small amount of pee escaping every time I sneezed or coughed otherwise known as pelvic stress incontinence. I asked my obstetrician if there was anything I could do to prevent the incontinence from worsening. She told me that what I was experiencing was normal from the weight of the baby pressing on my bladder and that it would go away after I gave birth without taking any preventative measures.
This could not be further from the truth.
The rest of my pregnancy was uneventful thankfully. The morning of my son’s birth my water broke and I gave birth a few hours later vaginally with an epidural. I had a second degree tear to my perineum which was painful and at the time I thought would be the only challenge for my body in the healing process post delivery.
I was so wrong.
You see, all the preparation I had done during my pregnancy was for the baby and for my birthing plan. I had done zero preparation for the postpartum recovery of my body.
I think I simply thought, “Nature gave us the ability to grow, carry and birth tiny humans…surely nature would heal our bodies to enable us to nurture our babies.” I was still in the “young” category for having children and I was healthy and active. Really, what did I have to worry about?
Apparently a lot.
After I gave birth to my son I was kept in the hospital for 24 hours and then discharged. It was the height of covid and all mothers and babies were being discharged quickly in order to stop the spread of the virus. In hindsight staying an extra day or two definitely would have been helpful to ensure my baby was drinking enough breast milk and for any tips the nurses could give us. During our 24 hour stay I saw a lactation specialist once. She did two things: gave me the business card of an outpatient lactation consultant to call if I had any problems breastfeeding and checked my baby’s latch (once).
When I got home my son cried constantly and we could not figure out why. A few days later we called the outpatient lactation consultant (I highly recommend doing this) who came and told us that my son had lost a tremendous amount of weight from not drinking enough from my breast. She taught us how to finger feed him my breast milk. Finally, my son started to gain weight and was sleeping better. She also taught me how to use my pump and how to care for my nipples. It was only a few days of breastfeeding and already my nipples were cracked, swollen and painful.
I wish I had been given preventative guidance on the importance of caring for your nipples and breasts before I gave birth. Things like using nipple cream, nipple guards, hot and cold packs for your breasts, finding the correctly sized breast pump attachment for your nipple were not emphasized in my breast feeding class. Not only did I experience sore, cracked nipples, I had breast engorgement (breasts are swollen and painful because they’re overly full of breast milk), and mastitis (infection of breast tissue) with fevers every 2 weeks for the first 2 months of his life. Because of this and my son’s inability to drink enough milk from my breast, I switched my son to formula when he was 2 months old.
At my 6 week check up with my obstetrician I was given the green light to start exercising again. It was confusing to me because I definitely did not feel ready to exercise. I could still feel the healing scar from my second degree tear in my perineum and I had lower back pain when walking from my weak core. I tried to do a dance workout and found that I was weak and definitely not ready for the jumping. I decided to wait and at around week 10 I tried again and found that I could not jump without peeing significantly. My pelvic stress incontinence had not just disappeared like my obstetrician had said, in fact, it got worse. I spoke to my obstetrician and she recommended that I start pelvic floor physical therapy.
It was around this time that I started to feel numbness and tingling in my right hand. At first it was just in my fingertips, then it started to spread to my entire hand. I tried to compensate by using my left hand more, hoping that the numbness would go away in my right hand with less use. About a week later my left hand became numb. Then the numbness became constant, I could not feel anything in both of my hands. My husband had to take over caring for our son because I could not carry him. I couldn’t feel my hair when I took a shower, I couldn’t cut my food when eating or cooking. I was so scared that this could be permanent. My obstetrician told me that this is not uncommon (completely shocking to me) and referred me to a sports medicine doctor. I was diagnosed with nerve damage in both of my elbows. My sports medicine doctor said that this is something that can happen to mothers postpartum.
All I could think is, “Ok if this is something that can happen, then why are we not warned? Why are we not given instructions on how to ergonomically carry our babies with our lack of core strength and swollen postpartum bodies? Why is there no preventative care given for issues like mine?”
At first the sports medicine doctor gave me written exercises to do at home and told me that my symptoms should resolve in 2 weeks. The exercises took me hours to do and did not help. Two weeks later I asked her for occupational therapy (OT). I went to Spear physical therapy, where I was also getting my pelvic floor therapy. My occupational therapist and my pelvic floor therapists helped me tremendously.
At 15 months postpartum my nerve damage is healed. I still struggle with repetitive muscle strain in my upper body, but I can manage this with rest and stretching. I am very slowly working my way back to practicing yoga and doing full weight bearing on my arms. I am a full time mom, so my arms, upper body and core get a lot of exercise caring for my son everyday. Upper body stretching and strengthening exercises plus incorporating proper body ergonomic techniques whenever I pick up my son, feed him, diaper change him, etc. have helped to prevent further injury and to strengthen my upper body and core.
As for my pelvic floor, it took me a year to recover my pelvic floor muscles through weekly physical therapy for 6 months, plus daily pelvic floor exercises at home. Stress incontinence that doesn’t resolve over a period of time with physical therapy is considered a chronic issue. Therefore, I will need to continue to do these exercises on an as needed basis to keep my pelvic floor muscles strong. My obstetrician let me know that carrying another baby will put stress on my pelvic floor and may worsen my incontinence. If I do not want anymore children after my second, there is surgery that can fix my incontinence issue.
It was very important to me that I stay active and exercise in any way that my body could handle after I gave birth. Because exercise was so ingrained in my daily life before I had a baby, it was imperative for my mental health that I continue to exercise.
During the period of time when my pelvic incontinence was at it’s worst, maybe around 6 or 7 months, I decided to try doing stationary biking. I thought that this was the safest cardio exercise other than walking that my body could handle at the time. The intense jumping and dancing workout felt like it was still too much for my body. One day when I was standing up on the bike and pedaling, I felt a pain in the back of my right ankle. Soon after I realized that I could not stand and walk or stretch my foot upwards without a shooting pain in the back of my ankle. I saw a podiatrist who diagnosed me with an achilles strain and put me in a soft cast for a week to allow my achilles to rest and recover.
He also explained to me that I had developed bunions from the pregnancy. The weight gain and postural changes can cause a bony bump to form at the joint on the base of the big toe. The pressure from the weight gain plus changes in your posture and gait can push some of the bones in the front part of the foot to move out of place. Bunions that are left untreated can become very painful and may require surgery later in life. There is also a genetic component to bunions. My grandmother on my father’s side had extremely severe bunions.
I was in shock when the podiatrist told me. I asked him if there was something I should have done when I was pregnant to prevent the bunions from developing in the first place and what I could do now to prevent them from getting worse. He told me that the most common mistake pregnant women do is wear the wrong footwear during pregnancy and recovery. Many women walk around the house in bare feet or unsupportive slippers on hard wood floors and carpets, carrying extra pregnancy weight, which changes your posture and weight distribution throughout your feet. Wearing supportive footwear in the house while pregnant and after baby is born is essential. Footwear like orthotic slippers provide cushion for your joints and feet especially when squatting down to pick up, carry, and walk around with your baby. This can prevent things such as plantar fasciitis and other painful issues. In order to prevent my bunions from worsening, the podiatrist recommended orthotics to ensure my feet were in the correct position anatomically to prevent my feet from over pronating. I changed my shoes to ones that could accommodate my orthotics. I gave away a majority of my pre pregnancy shoes, which felt like giving away a part of my youth, beauty and health.
At 17 months postpartum I felt I was doing a lot better. I still struggled with muscle tightness in my forearms and slight mommy’s wrist in both of my arms, but at least the nerve damage was mostly healed and my OT felt confident these remaining issues would heal over time with therapy. However, my achilles tendon in my right ankle still bothered me at times, especially when doing yoga and eventually it worsened to the point that it bothered me walking.
I should also mention that I had a previous work related injury to my right ankle in my mid-twenties. While wheeling a patient to recovery from the operating room, the stretcher was pushed over my foot and pushed my ankle inwards causing significant bruising and swelling. I was out of work for 3 months and it took doing physical therapy for a few months to regain strength in my foot and ankle. My right ankle has never really been the same.
I mentioned this injury to my obgyn at my 6 week check up because I was concerned that the pregnancy may have put extra strain on my injured ankle. I wondered if I should do physical therapy first to strengthen and stretch my foot and ankle in order to prevent injury before starting my dance and yoga exercise routine.
My obgyn told me that I had nothing to worry about and to continue to exercise as normal.
Clearly this was incorrect advice. Having a previous musculoskeletal injury prior to becoming pregnant in many cases can become aggravated by the weight gain and postural changes. As your body’s hormones re-regulate some ligaments lengthen and some shorten as they grow back during the postpartum period. Assessing these injuries initially postpartum, I believe, is key to a healthy and pain free recovery.
My podiatrist recommended physical therapy for my ankle. Four months later I am now finally able to walk and squat without discomfort, use the elliptical, dance and slowly get back into doing yoga again.
My son is now 21 months old and this is the best I’ve felt since he was born. The pain in my arms is gone. I can finally weight bear on my wrists. I can cook, write and type again. I continue to do my pelvic floor exercises every other day.
It has been a long and difficult journey to recovery. There is not a day that my body is without pain that I take for granted. The most frustrating part for me is that my injuries were for the most part preventable. I continue to listen to my body everyday and modify to use ergonomic ways to cook, type, lift etc. in order to continue to keep my body in good shape.
Facing the reality of what pregnancy had done to my body was extremely difficult. I was not mentally prepared to give up so much of what I loved to do - yoga, dancebody. It was devastating to not be able to care for my child when he was 2 months old. This put so much stress on our family, especially my husband. Having these issues postpartum took some of the joy away from having our first child. I was mentally prepared for the lack of sleep and 24/7 care of our baby.
I was not prepared for what happened to me.